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Case 13-17039-elf Doc 20 Filed 08/25/13 Entered 08/25/13 22:05:35 Desc Main

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B 7 (Official Form 7) (04/13)

UNITED STATES BANKRUPTCY COURT
EASTERN DISTRICT OF PENNSYLVANIA

In re: Amin Mohammad, Debtor

Case No: 13 - 17039 MDC
Chapter 7

STATEMENT OF FINANCIAL AFFAIRS

This statement is to be completed by every debtor. Spouses filing a joint petition may file a single statement on which the

information for both spouses is combined. If the case is filed under chapter 12 or chapter 13, a married debtor must furnish information
for both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed. An individual
debtor engaged in business as a sole proprietor, partner, family farmer, or self-employed professional, should provide the information
requested on this statement concerning all such activities as well as the individual’s personal affairs. To indicate payments, transfers and
the like to minor children, state the child’s initials and the name and address of the child’s parent or guardian, such as “A.B., a minor child,
by John Doe, guardian.” Do not disclose the child’s name. See, 11 U.S.C. § 112 and Fed. R. Bankr. P. 1007(m).

Questions 1 - 18 are to be completed by all debtors. Debtors that are or have been in business, as defined below, also must complete
Questions 19 - 25. If the answer to an applicable question is “None,” mark the box labeled “None.” If additional space is needed for
the answer to any question, use and attach a separate sheet properly identified with the case name, case number (if known), and the
number of the question.

DEFINITIONS

“In business.” A debtor is “in business” for the purpose of this form if Debtor is a corporation or partnership. An individual debtor is

“in business” for the purpose of this form if Debtor is or has been, within six years immediately preceding the filing of this bankruptcy
case, any of the following: an officer, director, managing executive, or owner of 5 percent or more of the voting or equity securities of a
corporation; a partner, other than a limited partner, of a partnership; a sole proprietor or self-employed full-time or part-time. An
individual debtor also may be “in business” for the purpose of this form if Debtor engages in a trade, business, or other activity, other than
as an employee, to supplement income from the debtor’s primary employment.

“Insider.” The term “insider” includes but is not limited to: relatives of the debtor; general partners of Debtor and their relatives;
corporations of which Debtor is an officer, director, or person in control; officers, directors, and any persons in control of a corporate
debtor and their relatives; affiliates of Debtor and insiders of such affiliates; and any managing agent of the debtor. 11 U.S.C. § 101(2),
(31).

None
[]

1. Income from employment or operation of business

State the gross amount of income Debtor has received from employment, trade or profession, or from operation of the
debtor’s business, including part-time activities either an employee or in independent trade or business, from the beginning of
this calendar year to the date this case was commenced. State also the gross amounts received during the two years immediately
preceding this calendar year. (A debtor that maintains, or has maintained, financial records on the basis of a fiscal rather than a
calendar year may report fiscal year income. Identify the beginning and ending dates of the debtor’s fiscal year. If a joint petition is
filed, state income for each spouse separately. (Married debtors filing under chapter 12 or chapter 13 must state income of both
spouses whether or not a joint petition is filed, unless the spouses are separated, and a joint petition is not filed.)

YEAR
2013
2012
2011

AMOUNT
$ 14,400.00
15,360.00/61,720.00
246,915.00

SOURCE (if more than one)
wages
wages/business income
business income

None
[x] State the amount of income received by Debtor other than from employment trade or profession, or operation of the debtor’s

2. Income other than from employment or operation of business

business during the two years immediately preceding the commencement of the case. Give particulars. If a joint petition is filed,
state income for each spouse separately. (Married debtors filing under chapter 12 or chapter 13 must state income of both spouses
whether or not a joint petition is filed, unless the spouses are separated, and a joint petition is not filed.).

YEAR

AMOUNT

SOURCE

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3. Payments to creditors

2

Complete a. or b., as appropriate, and c.

None
[x] a.

Individual or joint debtors with primarily consumer debts: List all payments on loans, installment purchases of goods or
services, and other debts, to any creditor made within 90 days immediately preceding the commencement of this case if
the aggregate value of all property that constitutes or is affected by such transfer is not less than $600. Indicate with an asterisk
(*) any payments that were made to a creditor on account of a domestic support obligation or as part of an alternative repayment
schedule under a plan by an approved nonprofit budgeting and creditor counseling agency. (Married debtors filing under chapter
12 or chapter 13 must state payments by either or both spouses whether or not a joint petition is filed, unless the spouses are
separated, and a joint petition is not filed.)

NAME AND ADDRESS OF CREDITOR

DATES OF
PAYMENTS

AMOUNT PAID

AMOUNT STILL
OWING

None
[x] b. Debtor whose debts are not primarily consumer debts: List each payment or other transfer to any creditor made within 90 days

immediately preceding the commencement of the case unless the aggregate value of all property that constitutes or is affected by
such transfer is less than $6,225.* If Debtor is an individual, indicate with an asterisk (*) any payments that were made to a
creditor on account of a domestic support obligation or as part of an alternative repayment schedule under a plan by an approved
nonprofit budgeting and credit counseling agency. (Married debtors filing under chapter 12 or chapter 13 must include payments
and other transfers by either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint
petition is not filed.)

NAME AND ADDRESS OF CREDITOR

DATES OF
PAYMENTS/
TRANSFERS

AMOUNT PAID OR
VALUE OF
TRANSFERS

AMOUNT

STILL
OWING

None
[x]

c.

All debtors: List all payments made within one year immediately preceding the commencement of this case to or for
the benefit of creditors who are or were insiders. (Married debtors filing under chapter 12 or chapter 13 must include
payments of either or both spouses whether or not a joint petition is filed, unless the spouses are separated, and a
joint petition is not filed.)

NAME AND ADDRESS OF CREDITOR
RELATIONSHIP TO DEBTOR

DATES OF
PAYMENTS

AMOUNT

PAID

AMOUNT STILL

OWING

None
[ ]

4. Suits and administrative proceedings, executions, garnishments and attachments

a. List all suits and administrative proceedings to which Debtor is or was a party within one year immediately preceding the

filing of this case. (Married debtors filing under chapter 12 or chapter 13 must include information concerning either or both
spouses whether or not a joint petition is filed, unless the spouses are separated, and a joint petition is not filed.)

CAPTION OF SUIT
AND CASE NUMBER

Halimah Davis vs. A.M., et al 11-11-02432
Cmwlth of PA vs. A.M. 2013-061029

NATURE OF
PROCEEDING

premises liability
tax lien

COURT OR AGENCY

AND LOCATION

Phila CCP
Delco CCP

STATUS OR
DISPOSITION

stayed
stayed

* - amount subject to adjustment on 4/01/16, and every three years thereafter with respect to cases commenced

on or after the date of adjustment.

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b. Describe all property that has been attached, garnished, or seized under any legal or equitable process within one year

immediately preceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include
information concerning property of either or both spouses whether or not a joint petition is filed, unless the spouses are
separated, and a joint petition is not filed.)

NAME AND ADDRESS OF PERSON FOR

WHOSE BENEFIT PROPERTY WAS SEIZED

DATE OF
SEIZURE

DESCRIPTION AND VALUE

OF PROPERTY

7. Gifts
List all gifts or charitable contributions made within one year immediately preceding the commencement of this case except
ordinary and usual gifts to family members aggregating less than $200 in value per individual family member and charitable
contributions aggregating less than $100 per recipient. (Married debtors filing under chapter 12 or chapter 13 must include gifts
or contributions by either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint
petition is not filed.)

NAME AND ADDRESS OF

PERSON OR ORGANIZATION

RELATIONSHIP TO
DEBTOR, IF ANY

DATE OF GIFT

DESCRIPTION AND

VALUE OF GIFT

8. Losses
List all losses from fire, theft, other casualty or gambling within one year immediately preceding the commencement of this
case or since the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include losses by
either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)
DATE OF LOSS

DESCRIPTION
AND VALUE OF

PROPERTY

DESCRIPTION OF CIRCUMSTANCES, AND IF
LOSS WAS COVERED IN WHOLE OR IN PART

BY INSURANCE, GIVE PARTICULARS

5. Repossessions, foreclosures and returns
List all property that has been repossessed by a creditor, sold at foreclosure sale, transferred through a deed in lieu of foreclosure
or returned to a seller within one year immediately preceding the commencement of this case. (Married debtors filing under
chapter 12 or chapter 13 must include information concerning either or both spouses whether or not a joint petition is filed,
unless the spouses are separated, and a joint petition is not filed.)

NAME AND ADDRESS

OF CREDITOR OR SELLER

DATE OF REPOSSESSION, FORECLOSURE,

SALE TRANSFER OR RETURN

DESCRIPTION AND

VALUE OF PROPERTY

6. Assignments and receiverships

a. Describe any assignment of property for the benefit of creditors made within 120 days immediately preceding the

commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include any assignments by either
or both spouses whether or not a joint petition is filed, unless the spouses are separated, and a joint petition is not filed.)
NAME AND ADDRESS

TERMS OF ASSIGNMENT

DATE OF

OF ASSIGNEE

ASSIGNMENT

OR SETTLEMENT

b. List all property which has been in the hands of a custodian, receiver, or court-appointed official within one year

immediately preceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include
information concerning property of either or both spouses whether or not a joint petition is filed, unless the spouses are
separated, and a joint petition is not filed.)

NAME AND ADDRESS OF
CUSTODIAN

NAME, LOCATION OF
COURT, CASE TITLE AND
NUMBER

DATE OF ORDER

DESCRIPTION,
VALUE OF
PROPERTY

None
[x]

None
[x]

None
[x]

None
[x]

None
[x]

None
[x]

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None
[ ]

9. Payments related to debt counseling or bankruptcy
List all payments made or property transferred by or on behalf of Debtor to any persons, including attorneys, for consultation
concerning debt consolidation, relief under the bankruptcy law or preparation of a petition in bankruptcy within one year
immediately preceding the commencement of this case.

NAME AND ADDRESS

OF PAYEE

Access Counseling
Ronald G. McNeil, Esquire

07/30/2013
08/05/2013

DATE OF PAYMENT,
NAME OF PAYOR, IF
OTHER THAN DEBTOR

AMOUNT OF MONEY, OR

DESCRIPTION AND

VALUE OF PROPERTY

$15.00
$1,194.00

10. Other transfers

a. List all other property, other than property transferred in the ordinary course of the business or financial affairs of Debtor,

transferred either absolutely or as security within two years immediately preceding the commencement of this case.
(Married debtors filing under chapter 12 or chapter 13 must include transfers by either or both spouses whether or not a joint
petition is filed, unless the spouses are separated and a joint petition is not filed.)

NAME AND ADDRESS OF TRANSFEREE,

RELATIONSHIP TO DEBTOR

DATE

DESCRIBE PROPERTY TRANSFERRED

AND VALUE RECEIVED

b. List all property transferred by Debtor within ten years immediately preceding the commencement of this case to a self-

settled trust or similar device of which Debtor is a beneficiary.

NAME OF TRUST OR

OTHER DEVICE

DATE(S) OF
TRANSFER(S)

AMOUNT OF MONEY OR DESCRIPTION AND

VALUE OF PROPERTY OR DEBTOR’S

INTEREST IN PROPERTY

None
[x]

None
[x]

None
[x]

11. Closed financial accounts
List all financial accounts and instruments held in the name of Debtor or for the benefit of Debtor which were closed, sold or
otherwise transferred within one year immediately preceding the commencement of this case. Include checking, saving, or other
financial accounts, certificates of deposit, or other instruments; shares and share accounts held in banks, credit unions, pension
funds, cooperatives, associations and brokerage houses and other financial institutions. (Married debtors filing under chapter 12
or chapter 13 must include information concerning accounts or instruments held by either or both spouses whether or not a joint
petition is filed, unless the spouses are separated and a joint petition is not filed.)

NAME AND ADDRESS
OF INSTITUTION

TYPE OF ACCOUNT, LAST FOUR
DIGITS OF ACCOUNT NUMBER,

AND AMOUNT OF FINAL BALANCE

AMOUNT AND DATE
OF SALE OR CLOSING

None
[x]

12. Safe deposit boxes
List each safe deposit or other box or depository in which Debtor has or had securities, cash or other valuables within one year
immediately preceding the commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include
boxes or depositories of either or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint
petition is not filed.)
NAME AND ADDRESS

DATE OF TRANSFER

DESCRIPTION

OF BANK OR

OTHER DEPOSITORY

NAMES AND ADDRESSES
OF THOSE WITH ACCESS
TO BOX OR DEPOSITORY

OF

CONTENTS

OR SURRENDER,

IF ANY

None
[x]

13. Setoffs
List all setoffs made by any creditor, including a bank, against a debt or deposit of Debtor within 90 days preceding the
commencement of this case. (Married debtors filing under chapter 12 or chapter 13 must include information concerning either
or both spouses whether or not a joint petition is filed, unless the spouses are separated and a joint petition is not filed.)

NAME AND ADDRESS OF CREDITOR

DATE OF SETOFF

AMOUNT OF SETOFF

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None
[x]

14. Property held for another person
List all property owned by another person that Debtor holds or controls.

NAME AND ADDRESS

OF OWNER

DESCRIPTION AND

VALUE OF PROPERTY

LOCATION OF

PROPERTY

None
[ ]

15. Prior address of debtor
If Debtor has moved within three years immediately preceding the commencement of this case, list all premises which Debtor
occupied during that period and vacated prior to the commencement of this case. If a joint petition is filed, report also any
separate address of either spouse.

ADDRESS

14 Lexington Avenue
102 Bryn Mawr Ave

NAME USED

same
same

DATES OF OCCUPANCY

Nov/12 - present
Aug/10 + - Nov/12

None
[x]

16. Spouses and Former Spouses
If Debtor resided in a community property state, commonwealth, or territory (including Alaska, Arizona, California, Idaho,
Louisiana, Nevada, New Mexico, Puerto Rico, Texas, Washington, or Wisconsin) within eight years immediately preceding the
commencement of the case, identify the name of the debtor’s spouse and of any former spouse who resides or resided with
Debtor in the community property state.

NAME

17. Environmental Information
For the purposes of this question, the following definitions apply:

“Environmental Law” means any federal, state or local statute or regulation regulating pollution, contamination, releases of
hazardous or toxic substances, wastes or materials into the air, land, soil, surface water, groundwater, or other medium, including
but not limited to, statutes or regulations regulating the cleanup of these substances, wastes, or material.

“Site” means any location, facility, or property as defined by any Environmental Law, whether or not presently or formerly
owned or operated by the debtor, including but not limited to, disposal sites.

“Hazardous Material” means anything defined as a hazardous waste, hazardous substance, toxic substance, hazardous material,
pollutant, or contaminant or similar term under an Environmental Law.

a. List the name and address of every site for which Debtor has received notice in writing by a governmental unit that it may be

liable or potentially liable under or in violation of an Environmental Law. Indicate the governmental unit, the date of the
notice, and , if known, the Environmental Law.

SITE NAME

AND ADDRESS

NAME AND ADDRESS OF
GOVERNMENTAL UNIT

DATE OF NOTICE

ENVIRONMENTAL

LAW

None
[x]

None
[x]

b. List the name and address of every site for which Debtor provided notice to a governmental unit of a release of Hazardous

material. Indicate the governmental unit to which the notice was sent and the date of the notice.

SITE NAME
AND ADDRESS

NAME AND ADDRESS OF
GOVERNMENTAL UNIT

DATE OF NOTICE

ENVIRONMENTAL
LAW

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None
[x]

None
[ ]

c. List all judicial or administrative proceedings, including settlements or orders, under any Environmental Law with respect to

which Debtor is or was a party. Indicate the name and address of the governmental unit that is or was a party to the
proceeding, and the docket number.

NAME AND ADDRESS OF
GOVERNMENTAL UNIT

DOCKET NUMBER

STATUS OR
DISPOSITION

18. Nature, location and name of business

a.

If Debtor is an individual, list the names, addresses, taxpayer identification numbers, nature of the businesses, and beginning
and ending dates of all businesses in which Debtor was an officer, director, partner, or managing executive of a corporation,
partner in a partnership, sole proprietor, or was self-employed in a trade, profession or other activity either full-time or part-
time within six years immediately preceding the commencement of this case, or in which Debtor owned 5 percent or more
of the voting or equity securities within the six years immediately preceding the commencement of this case.
If Debtor is a partnership, list the names, addresses, taxpayer identification numbers, nature of the business, and beginning
and ending dates of all businesses in which Debtor was a partner or owned 5 percent or more of the voting or equity
securities, within the six years immediately preceding the commencement of this case.
If Debtor is a corporation, list the names, addresses, taxpayer identification numbers, nature of the businesses, and
beginning and ending dates of all businesses in which Debtor was a partner or owned 5 percent or more of the voting or
equity securities, within the six years immediately preceding the commencement of this case.

LAST FOUR DIGITS OF SOCIAL-
SECURITY OR OTHER
INDIVIDUAL TAXPAYER-I.D.
NO. (ITIN)/COMPLETE EIN
Amin Gas & Mini Mart, LLC 26-2381918

NAME

ADDRESS

NATURE OF
BUSINESS

4548 Baltimore Av
Phila., PA 19143

gas sales

BEGINNING AND
ENDING DATES

4/2/08 - 3/31/12

None
[x]

b. Identify any business listed in response to subdivision a., above, that is “single asset real estate” as defined in 11 U.S.C. § 101.

NAME

ADDRESS

The following questions are to be completed by every debtor that is a corporation or partnership and by any individual debtor
who is or has been, within six years immediately preceding the commencement of this case, any of the following: an officer, director,
managing executive, or owner of more than 5 percent of the voting securities of a corporation, a partner, other than a limited partner, of a
partnership; a sole proprietor, or otherwise self-employed in a trade, profession, or other activity, either full-or part-time.

(An individual or joint debtor should complete this portion of the statement only if Debtor is or has been in business, as

defined above, within six years immediately preceding the commencement of this case. A debtor who has not been in business within
those six years should go directly to the signature page.)

19. Books, records, and financial statements

None
[ ]

a. List all bookkeepers and accountants who within the two years immediately preceding the filing of this bankruptcy case,

kept or supervised the keeping of books of account and records of the debtor.

NAME AND ADDRESS

C. Thomas Maniaci, E.A.
6722 Frankford Avenue
Philadelphia, PA 19135

DATE SERVICES

RENDERED
Aug/11 + - present

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b. List all firms or individuals who within two years immediately preceding the filing of this bankruptcy case have audited

the books of account and record, or prepared a financial statement of Debtor.
NAME
same
None
[ ]

ADDRESS

DATES SERVICES RENDERED

c. List all firms or individuals who at the time of commencement of this case were in possession of the books of account

and records of Debtor. If any of the books of account and records are not available, explain.
NAME
same

ADDRESS

If Debtor is a corporation, list all officers and directors of the corporation, and each stockholder who directly
or indirectly owns, controls, or holds, 5 percent or more of the voting or equity securities of the corporation.

NATURE AND PERCENTAGE

OF STOCK OWNERSHIP

NAME AND ADDRESS

TITLE

22. Former partners, officers, directors, and shareholders

a.

b.

If Debtor is a partnership, list each member who withdrew from the partnership within one year immediately
preceding the commencement of this case.
NAME

DATE OF WITHDRAWAL

ADDRESS

If Debtor is a corporation, list all officers or directors whose relationship with the corporation terminated
within one year immediately preceding the commencement of this case.
NAME AND ADDRESS

DATE OF TERMINATION

TITLE

d. List all financial institutions, creditors, and other parties, including mercantile and trade agencies, to whom a
financial statement was issued within the two years immediately preceding the commencement of this case.
NAME AND ADDRESS

DATE ISSUED

same

20. Inventories

a. List the dates of the last two inventories taken of your property, the name of the person who supervised the taking of each

inventory, and the dollar amount and basis of each inventory.
DATE OF INVENTORY

INVENTORY SUPERVISOR

DOLLAR AMOUNT
OF INVENTORY
(Specify cost, market, or other basis)

b. List the name and address of the person having possession of the records of each of the two inventories reported

in a., above.

DATE OF INVENTORY

NAME AND ADDRESSES OF
CUSTODIAN OF INVENTORY RECORDS

21. Current Partners, Officers, Directors and Shareholders

If Debtor is a partnership, list the nature and percentage of partnership interest of each member of the partnership.
NAME AND ADDRESS

PERCENTAGE OF INTEREST

NATURE OF INTEREST

None
[ ]

None
[ ]

None
[x]

None
[x]

None
[x]

None
[x]

None
[x]

None
[x]

a.

b.

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